Poor people have multiple chronic diseases ten years before rich people

Poorer people start to have two or more chronic diseases ten years earlier than the richest, shows a study published in the scientific journal Nature Reviews Disease Primers. The survey suggests guidelines on how to deal with the problem, which already affects about 25% of Brazilians.

The study is an initiative of ten scientists from Denmark, the United Kingdom, Canada, Peru, the United States, India, Tanzania, Ireland and Brazil. It compiles and analyzes previous research on so-called multimorbidity, summarizes what has already been published, and offers guidance for healthcare professionals and researchers.

Among the data listed are the higher frequency of concurrent chronic diseases among women and the strong association between multimorbidity and age: there is a prevalence of 30% in the 45-64 age group, 65% in the 65-84 age group and 82 % from 85 years of age.

“The elderly have, in percentage terms, more multimorbidity. However, in absolute terms, it is more frequent in adults. Thus, we cannot define multimorbidity as a specific problem of elderly people, even because the problem is addressed through a prevention approach since the beginning of life”, says researcher Bruno Pereira Nunes, professor at UFPel (Federal University of Pelotas) and co-author of the work.

In addition to aging, research shows that economic and social aspects have an impact on the occurrence of cases. According to the researchers, there are greater chances of multimorbidity in groups with less education and among individuals who live in poorer areas.

“Poverty and socioeconomic difficulties influence different aspects of individuals’ lives, being considered ‘the causes of the causes’ of the health situation. For example, there is a lot of talk that inadequate nutrition is a risk factor for diseases, but what is the cause? of inadequate nutrition? Usually, it is associated with the difficulty of obtaining a balanced diet, rich in fruits and vegetables, which goes through socioeconomic issues. And, unfortunately, it is related to hunger and food insecurity, which are increasing in Brazil “, explains Nunes.

Also in this sense, the study takes up a Scottish research according to which multimorbidity occurs ten years earlier in people with greater socioeconomic vulnerability. “All countries need to deal with the occurrence of multiple chronic diseases. However, in middle and low-income countries, the challenges are greater due to social inequalities and poverty levels that impact from prevention to treatment”, says the researcher. .

Regarding the habits that may favor the emergence of multimorbidity, scientists emphasize smoking, low levels of physical activity, high BMI (body mass index), high intake of chicken or red meat, alcohol consumption and excessive or insufficient duration. of sleep. “As physical inactivity is a risk factor for several chronic conditions, it is of particular relevance for the prevention of multimorbidity in all age groups, especially in individuals from an economically disadvantaged background”, the researchers point out in the article.

They also recommend that physicians, health managers and public policy makers define guidelines and focus measures considering three main areas: targeting patients, supporting healthy behaviors and providing care with a focus on interdisciplinarity.

“Health systems and services are still not prepared to deal with multimorbidity, and the pandemic may have worsened the situation with the increase in social inequalities. Despite this, Brazil may be in a privileged position because we have the SUS (Sistema Único In Brazil, the SUS and the Family Health Strategy are able to provide this care to the entire population, as long as they have sufficient funding and quality management”, says Nunes.